EL-09-1232oila4loa
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PERMIT APPLICATION
FBC 20
Job Address (where the work is being done)
Is Building Historically Designated YES NO
Contact Phone
Architect/Engineer's Na
Value of Work For.
Type of Work:
Describe Wo
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Submittal Fee $ Permit Fee $
Miami Shores Village r} T E v IE
Buildih epartment JUL 2 3 AM ID
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 BY:
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING Permit NoE m 2
Permit Type; ELECTRICAL y,._ ,
Owner's Name (Fee Simple Titleholder) .Cl 15t ' �` ti^' Z- Phone # 5 61 zi2. So 71
Owner's Address 124' N 1_ ' ,
City lill1 ',MSS State 'V1 - . Zip 331 "5 23
Tenant/Lessee Name Phone #
Email
126 p.
City Miami Shores Village County Miami -Dade Zip '31 e i �!
FOLIO / PARCEL # • 11 " 52 -050 -- 071 '313.0
Contractor's Company Name j..,j[, u'JC. Phone # 30.8 S S Li B. 20
Contractor's Address 1 921 S c..1 109 ArtuE 4# tot
City M)]4MI State Ft
Qualifier Name iSc . & - Phone # SOS sr'/ N8 to
State Certificate or Registration N c lao D. 49 0
Phone #
teration
LJNew Ir,�:
L fw' "AEI. c a/1e ice :
N IPS 0
Square / Linear Footage Of
' eplace ❑ Demolition
C.4
E -mail
Peas
Master Permit No.
r �
Zip 33 - 4 4 1
Certificate of Competency No. •
Bond $
Notary $
Scanning $ 0'0 '0 Radon $ DPBR $
Double Fee $ Violation date: pp q J'�
Structural Review. $ Total Fee Now Due $ 1 `S b O
Flood Zone
*********** ** **** ******* ******** ****** ****
CCF $ 0 o CO /CC $
Training/Education Fee $ 0'9.0 Technology Fee $
Seem Reverse side -4
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for FI FCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be 1 roved and a reins ctio fe will be charged
Signature
Own ;f' or g
The foregoing instrument was acknowledged before me this 0'S
day of _ t 20' by •rfQr+C/SCD Ileer es-,d g" Z,
who is perso know n to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: ■—e-A-te c-t�
Print: /1/ I ph
My Commission Expires:
* * * * * * * * * * * * * * * * **
APPROVED BY
*
(Revised 07 /10 /07XRevised 06 /10/2009)
Engineer
Signature
ontractor
The foregoing instrument was acknowledged before me this
day of , 20 _ , by
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
A YsJ07I Print:
NOTARY PUBLIC -STATE OF ROMA My Commission Expires:
Milena Paparani
Commission #DD685086
• . ,,.•' Expires: JUNE 13, 2n11
'* i' iilifeiii*Pirti*: s**C*************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
)4i ®' Tans Examiner Zoning
Clerk checked
Inspection Number: INSP- 139236 Permit Number: EL -7 -09 -1232
Scheduled Inspection Date: March 31, 2010
Inspector: Devaney, Michael
Owner: HERNANDEZ, FRANCISCO
Job Address: 126 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: LIGHTGATE INC
Building Department Comments
ELECTRICAL TEMPORARY FOR REMODELING
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP- 137023. CREATED AS
REINSPECTION FOR INSP- 130607. work in progress needs 30 days temp
for test. not ready for final. MD 12/03/09Need to hot check,
, 9 j 2_
1
March 30, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
RC-3-09 ° '123
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Temp for Construction
Phone Number (786)282 -9014
Parcel Number 1132060133130
Phone: 305 - 554 -4820
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